Sørensen Karam Matlub, Qvist Niels
Research Unit of Surgery, Odense University Hospital, J.B. Winsløws, Vej 4, 5000, Odense C, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Surg Endosc. 2025 Mar;39(3):2073-2079. doi: 10.1007/s00464-025-11585-9. Epub 2025 Feb 3.
Surgical repair for high anal fistulas is challenging and can be associated with impaired functional outcomes. This study evaluated the long-term results of transsphincteric fistulectomy with primary sphincter repair for high anal fistulas in terms of recurrence, wound healing, fecal incontinence, and quality of life.
This retrospective cohort study included patients who underwent surgical repair for high anal fistulas between 2006 and 2015. Data were collected by reviewing patients' electronic hospital records, including demographic characteristics, medical conditions, surgical findings, performed procedures, and follow-up data until the last recorded visit. Functional outcomes were assessed using self-reported online questionnaires for quality of life (RAND SF-36) and fecal incontinence (Wexner score).
Fifty-five patients were included. Primary healing was achieved in 42 (76%) patients, while 13 (24%) experienced recurrence. Following reoperations for recurrence, an additional 12 patients achieved healing, resulting in an overall healing rate of 98%. The median Wexner score was significantly higher in reoperated patients, and the median scores across all eight parameters of the RAND SF-36 were lower. None of the patients required proctectomy, and two ended with permanent stomas.
Surgery for high anal fistulas is associated with a high success rate, but reoperations for recurrence are linked to considerable impairment in functional outcomes.
高位肛瘘的手术修复具有挑战性，且可能与功能预后受损有关。本研究评估了经括约肌肛瘘切除术联合一期括约肌修复治疗高位肛瘘的长期疗效，包括复发情况、伤口愈合、大便失禁及生活质量。
这项回顾性队列研究纳入了2006年至2015年间接受高位肛瘘手术修复的患者。通过查阅患者的电子病历收集数据，包括人口统计学特征、医疗状况、手术发现、实施的手术以及直至最后一次记录就诊的随访数据。使用自我报告的在线问卷评估生活质量（RAND SF-36）和大便失禁（韦克斯纳评分）的功能预后。
共纳入55例患者。42例（76%）患者实现一期愈合，13例（24%）复发。复发后再次手术，又有12例患者愈合，总体愈合率达98%。再次手术患者的韦克斯纳评分中位数显著更高，RAND SF-36所有八个参数的中位数评分更低。无一例患者需要行直肠切除术，2例最终形成永久性造口。
高位肛瘘手术成功率较高，但复发后的再次手术与功能预后的显著受损有关。
